Provider Demographics
NPI:1982722617
Name:NGUYEN, ALAN SON (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SON
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 HIGH MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19060-1738
Mailing Address - Country:US
Mailing Address - Phone:267-303-7274
Mailing Address - Fax:
Practice Address - Street 1:3009 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703
Practice Address - Country:US
Practice Address - Phone:302-793-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001295122300000X
NJ22DI023210001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice